Neurosurgery
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Biography Historical Article
E. Latunde Odeku: the first African-American neurosurgeon trained in the United States.
The advances of the Civil Rights movement in the mid-20th century and the success of the first African-American neurosurgeons trained at the Montreal Neurological Institute have led to a number of African-Americans receiving neurosurgery training within the United States. Unfortunately, the details regarding the first African-American neurosurgeon trained in the United States, E. Latunde Odeku, have largely remained in obscurity. ⋯ C. S., enabled him to become the first African-American neurosurgeon trained in the United States. A truly global pioneer, his selfless service in America and Nigeria opened the door for people from each country to enhance the field of neurosurgery.
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For this study, spheno-orbital meningiomas (SOMs) are defined as intraosseus meningiomas at the base of the anterior and middle cranial fossa, involving the sphenoid wing and orbit associated with a carpet-like, soft tissue component. We describe a surgical series of 63 SOMs, including surgical technique, complications, and recurrences. ⋯ Complete surgical resection of SOMs is frequently impossible because the involvement of delicate structures of the orbital cone is common. Although some persisting neurological deficits are possible, proptosis and other visual deficits are often relieved. Two-thirds of tumor rests remained stable during the follow-up period. Consequently, the surgical aim should be the relief of leading symptoms rather than radical resection.
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Clinical Trial
Neuronavigation without rigid pin fixation of the head in left frontotemporal tumor surgery with intraoperative speech mapping.
Intraoperative speech mapping has evolved into the "gold standard" for neurosurgical removal of lesions near the language cortex. The integration of neuronavigation into a multimodal protocol can improve the reliability of this type of operation, but most systems require rigid fixation of the patient's head throughout the operation. This article describes and evaluates a new noninvasively attached sensor-based reference tool, which can replace rigid pin fixation of the patient's head during awake craniotomies. ⋯ The use of a reference sensor can replace uncomfortable pin fixation of the patient's head during navigation-supported awake craniotomies. Application accuracy is not affected by repositioning of the patient or by unavoidable head movements. Thus, this technique enables full exploitation of the benefits of navigation in a multimodal operative protocol without the need to rigidly fix the patient's head.
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Treatment of posterior circulation aneurysms poses a great technical challenge for the practicing neurosurgeon. The advent of endovascular techniques has made such treatment more feasible. We report our experience with the endovascular management of ruptured and unruptured posterior circulation aneurysms during the past 10 years. ⋯ Endovascular coil embolization of posterior circulation aneurysms is an effective treatment in the short term but is associated with recurrence, which requires close surveillance, possible retreatment, and can, albeit very rarely, lead to rehemorrhage. Future technological advancements such as the development of biologically active coils will be essential in the permanent obliteration of aneurysms.
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Diffuse arteriovenous malformations (AVM) have non-compact niduses, irregular margins, and intervening brain parenchyma. Deep perforating arteries often contribute to the ragged border of these diffuse AVMs. We hypothesized that diffuseness and deep perforator supply increase the difficulties and risks associated with microsurgical AVM resection. ⋯ Diffuseness and deep perforating artery supply are subtle features of an AVM that predict worse outcomes after microsurgical resection. Diffuseness makes surgical planes more difficult to determine and follow, whereas deep perforators are friable, poorly visualized, and located in eloquent white matter tracts. The Spetzler-Martin grading scale does not directly account for these two features; however, they should be considered carefully when making treatment recommendations to patients with AVMs.